Abstract
The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. Canadian International Polar Year Inuit Health Survey (2007-2008). Inuit adults (n 777). Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.
Highlights
The prevalence of glucose intolerance was similar for men (18·6 %) and women (17·0 %) despite significant sex differences in the prevalence of risk factors, where women compared with men were more likely to be obese (44·6 % v. 27·7 %; P < 0·05), have an at-risk WC (63·7 % v. 27·8 %; P < 0·05) and have an at-risk %BF (68·9 % v. 40·6 %; P < 0·05)
History of diabetes was missing for 25·0 % of men and 22·7 % of women; the percentage of glucose intolerance tended to be higher among those either reporting a family history of diabetes or missing information on family history, with significant group differences noted for men (Table 1)
In analyses where we substituted %E from protein with %E from carbohydrate, we found that %E from carbohydrate above v. below the Acceptable Macronutrient Distribution Range (AMDR) was not associated with glucose intolerance (Table 3, model 2)
Summary
A cross-sectional Canadian International Polar Year Inuit Health Survey was conducted in three jurisdictions (Inuvialuit Settlement Region of Northwest Territories, Nunavut Territory and Nunatsiavut region in Labrador) in 2007 and 2008(2,9). Households were randomly selected through randomization of community housing maps and lists and Inuit adults, 18 years of age or older, were invited to participate in the survey. A total of 2796 Inuit households were successfully visited by community research assistants and 1901 (68·0 %) households participated in the survey, with an average of 1·38 participants per household (n 2595). Due to survey logistical constraints, approximately 30 % of survey participants had a 75 g, 2 h oral glucose tolerance test (OGTT) either on board the Canadian Coast Guard Ship CCGS Amundsen which assisted the research in thirty-three coastal communities or at clinic sites in three land-based surveys for inland communities. Of the original 2595 adults who participated in the survey, only those with a completed OGTT and without pre-existing diagnosed diabetes, as identified by medication or dietary treatments, were included in the present analyses (n 777). Fasting (>7·5 h) venous blood samples were collected and kept cool before being centrifuged and frozen at −80°C until later analyses of plasma glucose assessed by the Glucose Hexokinase II method[20], handled by Nutrasource Diagnostics (Guelph, Ontario, Canada)
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